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General NPI Number Information
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NPI Number | 1336503358
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Entity Type | Organization
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Legal Business Name | FAIRFAX HEARING CENTER, INC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 8120 GATEHOUSE RD 100
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1204
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Country | US
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Telephone | 703-204-2771
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 GATEHOUSE RD 100
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City | FALLS CHURCH
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State | VA
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Zip | 22042-1204
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Country | US
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Telephone | 703-204-2771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE R O'HALLORAN
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Credential | MD
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Telephone | 703-204-2771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 2201001221
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License Number State | VA
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